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Provider: Tameside and Glossop Integrated Care NHS Foundation Trust Good

On 04 July 2019, we published a report on how well Tameside and Glossop Integrated Care NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires Improvement  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 4 July 2019

Our rating of the trust stayed the same. We rated it as good because:

  • We rated safe, effective, caring, responsive and well-led as good. We rated eleven of the trust’s 12 services as good and one as outstanding. In rating the trust, we took into account the current ratings of the six services not inspected this time.
  • We rated well-led for the trust overall as good.
  • Since our last inspection, there had been improvement in the completion of mandatory training across the trust and the concerns raised within maternity services had been addressed.
  • There were enough staff with the right qualifications, competence, skill and experience, in most areas, to deliver care and treatment to meet patient’s needs.
  • Effective systems were in place to protect patients from abuse, manage patient risk and safety incidents and provide evidence-based care.
  • The trust controlled infection risk well. Equipment and premises were kept clean in most areas and there were systems and processes in place to prevent the spread of infection.
  • Staff cared for patients with compassion. Feedback from patients and most carers confirmed that staff treated them well and with kindness.
  • There had been significant work undertaken to prevent admission to hospital, support people in their homes and improve access and flow across the trust. There were demonstrable reductions in length of stay, a reduction in patient cancellations, reduction in long stay beds and evidence of admission avoidance.
  • Leaders were experienced and had the capability to make sure that a quality service was delivered and risks to performance were addressed. The executive and service level teams were delivering good operational performance as well as being focused on the development of the local integrated care system. There was evidence of compassionate, inclusive and effective leadership across the organisation.

However:

  • There were not enough children’s nurses and emergency paediatric consultants to deliver a consistent 24-hour paediatric emergency care service in line with national guidance (DH Facing the Future).
  • Within the Stamford Unit delivering community inpatient services, the therapy service was limited to five days a week; therapy staff did not feel they were able to offer rehabilitation as much as they wanted to.

Inspection areas

Safe

Good

Updated 4 July 2019

Our rating of safe improved. We rated it as good because:

  • We rated medical care, maternity and each community service as good for safe.
  • Staff knew how to protect patients from abuse and the service worked with other agencies to do so, staff had received training on how to recognise and report abuse and were able to give examples of when they had done this.
  • Since our last inspection, there had been improvement in the completion of mandatory training across the trust.
  • The trust controlled infection risk well. Equipment and premises were kept clean in most areas and there were systems and processes in place to prevent the spread of infection.
  • There were systems and processes in place to manage patient risk. Senior managers at the hospital were aware of patient safety risk through regular reporting structures.
  • The trust had effective systems for prescribing, giving, recording and storing medicines. We found patients we checked had received the right medicines at the right dose at the right time.
  • The trust managed patient safety incidents well, staff knew how to report incidents and these were investigated by managers and lessons learned were shared with staff. Changes were made following incidents to improve patient care.
  • The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. Managers used this to improve the service.

However

  • There were not enough children’s nurses and emergency paediatric consultants to deliver a consistent 24-hour service in line with national guidance (DH Facing the Future). On some medical wards we were not always assured that nurse staffing levels were appropriate for the acuity of the patients.
  • Records were not always fully completed on all medical wards, in the emergency department and in community end of life care.

Effective

Good

Updated 4 July 2019

Our rating of effective improved. We rated it as good because:

  • We rated urgent and emergency care, medical care, maternity, community children, young people and families and community end of life care as good for effective. We rated community adults as outstanding for effective. We rated community inpatients as requires improvement.
  • The trust provided care and treatment based on national guidance and evidence of its effectiveness. Managers ensured that staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them.
  • The trust made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service. Compliance rates with annual appraisal was high.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses, other healthcare professionals supported each other to provide good care.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent in most of the clinical areas we inspected.

However:

  • Within the Stamford Unit delivering community inpatient services, the therapy service was limited to five days a week; therapy staff did not feel they were able to offer rehabilitation as much as they wanted to.

Caring

Good

Updated 4 July 2019

Our rating of caring stayed the same. We rated it as good because:

  • We rated urgent and emergency care, medical care, maternity, community adults, community children, young people and families and community inpatients as good for caring. We rated community end of life care as outstanding for caring.
  • Staff cared for patients with compassion. Feedback from patients and most carers confirmed that staff treated them well and with kindness.
  • Patients and their families were treated with privacy and dignity in the interactions that we observed.
  • Staff provided emotional support to patients to minimise their distress when appropriate.
  • Staff involved patients and those close to them in decisions about their care and treatment.

Responsive

Good

Updated 4 July 2019

Our rating of responsive stayed the same. We rated it as good because:

  • We rated maternity, community children, young people and families and community inpatients and community end of life care as good for responsive. We rated medical care and community adults as outstanding for responsive.
  • There had been significant work undertaken to prevent admission to hospital, support people in their homes and improve access and flow, particularly through the services provided in the medical directorate. There were demonstrable reductions in length of stay, a reduction in patient cancellations, reduction in long stay beds and evidence of admission avoidance.
  • Technology had been used to improve productivity and understand service demand and capacity.
  • The service took account of patients’ individual needs in most areas, especially people in vulnerable circumstances. They provided informed choice and continuity of care and reflected people’s individual needs and preferences. Patients and their carers were central to the delivery of services.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with staff.

However:

  • We rated urgent and emergency care as requires improvement. There were limitations in the service provision to meet the needs of children attending the paediatric emergency department.
  • The trust did not meet the Royal College of Emergency Medicine recommendation that states that the time patients should wait from time of arrival to receiving treatment should be no more than one hour.

Well-led

Good

Updated 4 July 2019

Our rating of well-led stayed the same. We rated it as good because:

  • Managers at all levels had the right skills and abilities to run a service providing high quality, sustainable care. Leaders were experienced and had the capability to make sure that a quality service was delivered and risks to performance were addressed.
  • The trust and services had a vision and strategies for what they wanted to achieve and workable plans to turn it into action. The trust worked in partnership with the local clinical commissioning groups and the local authority to develop the strategy.
  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff told us that they felt proud to work for the service and felt respected and valued.
  • There was a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care could flourish.
  • There were effective systems in place for identifying risks, planning to eliminate or reduce them and coping with both the expected and unexpected. There was a risk register in place and risks were managed and reviewed. Managers were clear about the most serious risks within their service.
  • The services engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborate with partner organisations effectively.

Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 4 July 2019

Combined rating
Checks on specific services

Community health inpatient services

Good

Updated 4 July 2019

We had not rated this service before. We rated it as good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff kept equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had suitable premises and equipment and looked after them well.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • The service had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patient’s care and treatment and the records were completed and managed appropriately.
  • The service has systems in place that ensured that medicines were administered and stored safely. Patients received the medicines they were prescribed in a safe manner.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service monitored safety using information from a range of sources. The information was monitored over a period, to feed into service improvement.
  • Patients care and treatment was planned, delivered and monitored in line with current evidence-based guidance, standards, best practice, legislation and technologies.
  • Staff ensured that they gave patients enough food and drink to meet their needs and improve their health.
  • Staff gave pain relief to patients when required. There was an effective process to ensure patients’ pain relief needs were met and pain was well managed by the service.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • Staff members were supported to deliver effective care and treatment through recruitment, training and development. There was a clear approach for supporting staff and managers appraised staff member’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Patients were supported to make decisions and, where appropriate, their mental capacity was assessed, recorded and acted on in line with relevant legislation.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff tried to ensure that patients and those close to them were partners in decisions about their care and treatment.
  • The service planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs.
  • Patients could access the right care at the right time. Waiting times were minimal and managed in a manner that met patients’ needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose, based on shared values.
  • The trust used a systematic approach to continually improve the quality of its services.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them and coping with both the expected and unexpected.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with staff to plan and manage appropriate services and collaborated with partner organisations effectively.
  • There was a positive focus on continuous learning and improvement for all staff. Staff members said they were supported to develop their professional skills and encouraged to shared good practice and identify innovation.

However:

  • The therapy service was not provided at the weekend at the time of inspection.
  • Therapy staff did not feel they were able to offer rehabilitation as much as they wanted to meet individual patient need.

Community health services for adults

Outstanding

Updated 4 July 2019

This service has not previously been inspected. We rated it as outstanding because:

  • There were innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. This enabled patients’ needs to be met in the community setting, and wherever possible avoided the need for admission to hospital.
  • The service planned and provided services in a way that met the needs of local people. Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them. Outcomes for people who use services were routinely monitored, were positive and some exceeded expectations.
  • People could access community health services when they needed them. We saw that waiting times to access services were significantly better than all national targets and most locally set targets.
  • Staff were consistent in supporting people to live healthier lives, including identifying those who need extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they used every contact with people to do so.
  • There was compassionate, inclusive and effective leadership at all levels. Leaders at all levels demonstrate the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. All managers had a deep understanding of issues, challenges and priorities in their service.
  • There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.
  • The trust used a systematic approach to continually improving the quality of its services, safeguarding high standards of care and worked with other organisations to improve care outcomes.
  • Services were developed with the full participation of those who use them, staff and external partners as equal partners. Innovative approaches were used to gather feedback from people who use services and the public.
  • The service made sure staff were competent for their roles, had received mandatory training and received their appraisal.
  • The service had effective systems and processes in place to protect patients from abuse, assess, control infection risk and respond to patient risk.
  • The service had received a low number of complaints. Staff knew how to deal with complaints and concerns and complaints were acknowledged, investigated and responded to in an appropriate and timely way.

However:

  • The risk register did not always provide documentary evidence risks had been reviewed.
  • Staff did not have access to pictorial aids to assist when caring for a patient with additional needs.
  • Not all staff had the recommended equipment to use when assessing a patient for sepsis.

Community health services for children, young people and families

Good

Updated 4 July 2019

We had not previously rated this service. We rated it as good because:

  • Community services for children, young people and families directorate provided staff with training in safety systems, processes and practices and staff had a high level of compliance in training. Training was monitored by local managers and by the trust and was conducted on induction and on a regular basis.
  • The trust had an in-date safeguarding policy and training modules which were available to all teams in the directorate. Staff had a high level of compliance with training and staff we talked to in the directorate knew the policy existed and knew how to apply it to protect children and families.
  • The trust had an infection prevention and control policy and training module, which was available to all teams in the directorate. Training rates were high and audits with good outcomes were undertaken by staff to ensure compliance.
  • The directorate reported no incidents classified as never events and no serious incidents in the period to December 2018. Incidents were reviewed and monitored.
  • The directorate used evidence based policies and national guidelines across its services, these included guidance from the Department of Health and the National Institute for Health and Care Excellence.
  • Staff in the directorate understood the relevant consent and decision-making requirements of legislation and how this related to young people such as guidance for Mental Capacity Act 2005, Children’s Acts 1989 and 2004, Gillick competence 1985.
  • Staff of all professions in the directorate acted with compassion and respect towards the patients and families. We observed staff talking to patients and carers continually about what was happening and providing re assurance.
  • Staff teams understood and met the needs of local people and had introduced systems so that staff deployment met the need of high and low population areas.
  • The staff in the directorate were aware of the diversity of populations and the challenges faced by some of its communities. Staff had access to multi-lingual sources such as translation services to support patient care.
  • The directorates leaders had the skills, knowledge and experience to guide and lead staff. management were respected, seen as supportive and effective in their roles.
  • Leaders in the trust and in the directorate had a vison for children and families’ services which focused on promoting well-being and nurturing. The service planned to move to a more holistic model of care which was connective with other services to promote well-being.

Community end of life care

Good

Updated 4 July 2019

We rated it as good because:

  • The approach to end of life care was multidisciplinary with both internal and external parties and all worked together to support patients at the end of their lives.
  • Care was evidence based and the service benchmarked itself to other external providers to ensure best practice was always maintained.
  • End of life care services were planned, organised and delivered well.
  • Services were safe and well managed.
  • There was 24-hour cover for end of life services and processes in place to support more vulnerable patients and their families.
  • Care given was holistic and feedback from patients and their families described excellent care and treatment.
  • Patients and their families were truly respected and the nurse’s communication with the patients and their families was excellent. Staff were compassionate and caring and involved patients and their families in decisions about their care and treatment.
  • Consideration of privacy and dignity was consistently embedded in everything that the staff did and this was evident in the conversations we had with staff and observations taken on home visits.